Chapter 1327 The Meaning of Consultation?

The case is not long.

Just a few words.

But a lot of information can be seen.

Doctors sometimes see only a few medical records.

The first is to find the cause according to the symptoms, and the second is to infer the symptoms according to the cause.

At this point the patient's symptoms do not appear to be difficult to infer.

In terms of symptoms, the patient has sudden dizziness, weakness, etc., which should be the manifestation of hypovolemia, and also has sudden abdominal pain, abdominal distension and other irritating symptoms of intra-abdominal bleeding!

Physical signs: pulse rate, low blood pressure, and obvious signs of peritoneal irritation, which should indicate intra-abdominal lesions.

Blood routine showed that hemoglobin decreased progressively in the early stage of the disease, while MCV and MCH did not change significantly. On the contrary, Fib continued to be low and D-dimer increased significantly. These seemingly messy laboratory reports can clearly draw a conclusion. In line with the performance of acute blood loss!

So Chen Cang said directly: "Consider acute hemorrhagic disease!"

Chen Cang's diagnosis was almost given directly after the case was finished.

Several directors frequently looked sideways, full of admiration.

Although this diagnosis is not difficult, but... to get acute bleeding so quickly, a certain level is required.

And Chen Cang basically blurted out, which shows the solid foundation of the other party!

Huang Qiuying couldn't help nodding her head: "Yes, since it is a bleeding disorder and pain in the lower abdomen, both physical examination and imaging revealed an accessible solid mass in the pelvic cavity, and the patient has a history of gynecology, so I first consider Gynecological related diseases.

There are only a few diseases that can cause bleeding in gynecological diseases!

The first is pregnancy-related diseases: such as ectopic pregnancy, trophoblastic tumor, etc.;

Followed by ovarian or fallopian tube tumor rupture;

The last is ovarian endometrioma cyst rupture. "

Chen Cang nodded: "The patient has been postmenopausal for many years, so pregnancy-related diseases can be completely ruled out, and endometriotic cysts are unlikely!"

Thinking of this, Chen Cang suddenly asked, "Did the patient fall?"

Cui Jisheng nodded: "Yes, but... it just slipped to the ground lightly."

A light slip on the ground is not the same as a hard fall.

Huang Qiuying said: "Before the diagnosis of bleeding caused by gynecological diseases can be established, it is still necessary to exclude bleeding caused by other systems and other causes."

As the director of general surgery, He Zhiqian said, "We have discussed it before, surgical intra-abdominal bleeding diseases are generally seen in organ damage."

"However, the damage of solid organs such as liver, spleen, pancreas, etc., hollow organs such as stomach, intestine and gallbladder bile duct, etc.; in addition, there are vascular damage such as abdominal aorta, inferior vena cava, etc. Generally, these injuries are secondary In severe closed or penetrating injuries, pelvic vascular injury is mostly secondary to penetrating injuries, pelvic or lower extremity fractures.

Therefore, the patient only falls to the ground slowly after light activities, and there is no obvious fracture manifestation, which generally does not cause damage to the above-mentioned organs and tissues. "

He Zhiqian's remarks directly denied the possibility of the patient's organ damage.

Next, urology, hematology, endocrinology, and interventional departments began to discuss again.

Perhaps many people do not understand what consultation is?

This is the consultation, a presumptive diagnosis is given, and then the various departments make the diagnosis.

That's the benefit of division.

Every doctor is proficient in one area!

They are very good at diseases in their field.

Continue to reduce the possibility of patients.

An acute intra-abdominal hemorrhage may seem common, but a clear diagnosis cannot be given at this time.

Actually, this is medicine.

As one of the founders of the Johns Hopkins School of Medicine, Sir William Osler said: "Medicine is an uncertain science!"

At this point, the discussion heated up again.

The urology department rejected the possibility of injury to the bladder region of the patient, and temporarily disregarded urology-related diseases.

The inferences of the Department of Hematology focus on vascular damage. After all, chronic diseases such as long-term diabetes can cause vascular lesions, which can easily lead to bleeding.

Another round of discussions ended.

The crowd was silent again.

Generally speaking, consultation is actually a step-by-step process.

If the condition is diagnosed, that's all good to say.

but……

If this is the case today, after everyone has discussed it for a long time, the cause cannot be found.

Consultation will not be wasted!

The consultation will gradually turn into a pot-push meeting.

After all, a patient with such a difficult disease cannot be diagnosed, let alone treated.

In fact, it can only be said that the patient's condition is not bad.

If it is really critical, the first step may be to do an exploratory laparotomy.

Sometimes imaging studies have limitations.

Bleeding is definitely there, but the amount of bleeding is not very large.

At this moment, the office fell into silence again.

Huang Qiuying was also decisive: "Notify the operating room to prepare for an exploratory laparotomy!"

There's no point in delaying it now.

At this time, Chen Cang was constantly thinking about various possibilities.

The routine diagnosis has been completely thought through, but... it doesn't match the patient's symptoms.

It's no wonder that everyone's consultation and discussion have been unsuccessful for an hour.

At this moment, Chen Cang suddenly said, "Can I go see the patient?"

Huang Qiuying turned around and glanced at Chen Cang, only to realize that Chen Cang hadn't commented since he came.

Everyone also thinks that this kid Chen Cang... won't come to the scene, right? !

But no one would force Chen Cang, after all, he was just a doctor in training.

Give or not, he is not responsible.

but……

To be honest, these directors must not believe that Chen Cang can give the result.

Huang Qiuying saw that Chen Cang's serious appearance did not seem to be pretentious, and couldn't help but stunned for a moment: "Okay!"

While talking, Huang Qiuying took Chen Cang to the ward in person.

An old woman in her 60s was lying on the bed, clutching her stomach and moaning in pain.

Seeing Huang Qiuying coming, she was about to speak when she saw Chen Cang!

Suddenly, the old lady blushed: "Professor Chen!"

The old lady's husband Cui Jisheng couldn't help but said, "Wife, don't worry, Professor Chen can definitely diagnose it!"

The old lady nodded, and suddenly felt that her stomach didn't hurt as much: "Yes, yes! I believe Professor Chen!"

Chen Cang also sighed, the pressure is huge!

Only love and trust cannot be let down!

The surrounding directors had mixed expressions.

If Chen Cangzhen had a clear diagnosis, he would be very capable.

But... to be honest, this disease really has to be so simple, and it will not be up to now.

This kind of bleeding is absolutely rare!

Sure enough, after Chen Cang's palpation, he was in a deadlock, and he couldn't get an accurate answer for a long time!

However, Chen Cang's eyes are not perspective after all.

There is also no way to see what's inside the abdominal cavity.

The patient's pelvic hematoma appears to be an unsolved mystery.

Time flies by!

Chen Cang also racked his brains to think about it!

What are the acute abdomens?

His mind was like a search engine, constantly bringing in, thinking, and speculating.

Chen Cang suddenly thought of something, and quickly said: "Do a color ultrasound of the upper and lower limbs!"

Huang Qiuying frowned: "The upper and lower limbs? What's the point?"

When the doctor in the interventional department heard Chen Cang's words, his eyelids jumped!

"Yes, let's do a color Doppler ultrasound!"

Hearing the interventionist doctor's voice, Huang Qiuying no longer stopped him.

Gynecology itself has ultrasound, and the results come out soon!

The color Doppler ultrasonography of the upper and lower extremities also suggested thrombosis of the right femoral and popliteal veins!

The people who saw the result were a little dazed.

At this time, Chen Cang was so frightened that he was sweating profusely!